NEWSLETTER -SPRING 2009
|Dr. I. Howard Fine
After nearly 40 years of practice in Eugene, I have decided to make some changes in anticipation of retirement. Beginning May 1st, I will take three months off for personal time, returning in August to see patients on a limited basis. I plan to continue to travel, teach, and serve organized ophthalmology in various capacities. Ophthalmology has been my life-long passion and will remain an important part of my life.
The past 40 years have produced remarkable innovations in our field. Out-patient surgery is the norm for practically all cataract and refractive procedures. Incisions are smaller and safer. Foldable lens implants are readily available. Surgical techniques are safer and more efficient. Farsightedness, nearsightedness, astigmatism, and presbyopia can be corrected. This has indeed been the Golden Age of Ophthalmology. I am grateful for the trust you placed in me by allowing me to serve as your eye physician and surgeon.
I am equally grateful that my partners, Dr. Richard Hoffman, and Dr. Mark Packer, both outstanding surgeons and internationally acknowledged leaders, will continue to provide excellent care to our patients.
It has been a wonderful ride.
Thank you, I. Howard Fine, MD. [ top ]
Mark Packer, M.D
Your options have grown. Twenty years ago we offered only Radial Keratotomy (RK) for nearsighted individuals who wanted to see well without contacts or glasses. Ten years ago we offered Photo Refractive Keratectomy (PRK), LASIK and Multifocal Intraocular Lenses (MF IOLs) for the nearsighted, farsighted and presbyopic. Today we offer several varieties of multifocal IOLs, accommodative IOLs, and Implantable Collamer Lenses (ICL).
In thinking about your vision and the potential for vision correction surgery to improve your quality of life, the most important factor to consider has always been and continues to be your personal goal. I recently met a 57 year old woman whose personal goal was to be able to go kayaking in Puget Sound and see whales. She was an extremely high myope (very nearsighted, that is, and could see a postage stamp 4 inches in front of her face without her contacts, but not much else); she also had astigmatism (meaning that the focusing power of her eyes was the same in every direction – vertical images were focused more strongly than horizontal images) and presbyopia (meaning that, past the age of about 45, the accommodation or focusing power of the eye diminishes and we all need bifocals or reading glasses). Her basic concern was safety; she was afraid of being caught out on the water and not being able to see. For her, the best solution was Refractive Lens Exchange with an accommodative IOL. This approach gave her excellent distance vision without glasses or contacts, and the ability to read most things at an intermediate range. She still needed reading glasses for small print, but her fundamental goal was met and she was happy with the results. She was one big step closer to her goal.
So, what is your goal? If you tell us, we can give you the information you need to determine what technique and technology will help you reach it. A man I recently met is a retired physician who works as a day trader. He constantly views five monitors and has to read fine print on paper, too. His goal was to do all this without glasses. He was moderately nearsighted in both eyes, more in one than the other, and had astigmatism and presbyopia as well, like the sea kayaker. However, his goal was different; he wanted freedom from glasses in particular at intermediate and near range. For him, the best solution was a combination of different multifocal IOLs in each eye. He also achieved freedom from glasses for driving and other far distance dominant visual activities, but these were secondary considerations.
Today, the variety of technology available for vision correction has grown and developed; the choices and options have become more complex. Because we offer all of the different technologies (and, in fact, serve as consultants and investigators for many of the companies that have developed these technologies) we know them inside and out and can help guide you to the best means to achieve your goal. [ top ]
| Richard S. Hoffman,
Astigmatism is a refractive error of the human eye that results from light images not being focused onto the back of the eye at one point. When an individual is nearsighted or farsighted and they do not have astigmatism also, light images are focused either in front or behind the retina at one point. When astigmatism is present, the light images are usually focused to two points rather than one. This “doubling” of the focal points results in “doubling” or shadowing of images in addition to blurring of the image.
The most common cause for astigmatism resides in the human cornea which is the clear outer surface of the eye. When the cornea has more of a football-shaped surface than a baseball-shaped surface, it creates two focal points around the retina. This results from the curve of the cornea in one direction having more or less light bending power in it than the curve 90 degrees away. Although the human cornea is the most likely site for induced astigmatism, the human crystalline lens is also a ref racting surface in the eye and can be responsible for astigmatism in some patients.
The easiest method of treating astigmatism is with glasses that have the astigmatic correction ground into the lenses. Astigmatism can also be corrected with soft-contact lenses that have the astigmatism correction and any nearsighted or farsighted correction incorporated into them. Hard or rigid gas-permeable contact lenses will also treat astigmatism by lying over the footballshaped cornea and allowing the baseball-shaped (spherical) contact lens to act as the new refractive surface of the eye – delivering one focal point.
Astigmatism can also be treated surgically by reshaping the football-shaped cornea with relaxing incisions in the steep curve of the cornea or using the excimer laser to reshape the cornea into a spherical shape with LASIK or PRK. When patients have cataracts that need removing and also have corneal astigmatism, the astigmatism can be corrected at the time of the cataract surgery (or in a separate procedure afterwards), with relaxing incisions, excimer laser refractive surgery, or intraocular lens implants that have the astigmatic refractive error incorporated into the lens implants.
Most individuals have small astigmatic refract ive errors that are usually easily tolerated and in most circumstances do not need to be addressed. However, when the astigmatism is large enough to affect the quality of vision, we have numerous methods for correcting it. [ top ]
New patient portal – surf us!
We’re pleased to announce a new service designed to enhance the way you communicate with your physician and manage your healthcare. We have added new capabilities to our practice web site, www.finemd.com, so that you will be able to:
- Email you doctor (nonurgent clinical questions)
- Email our practice (billing questions)
- Request an appointment
- Request medication and contact lens renewals
- Request referrals New patient portal – surf us!
- Fill out office registration forms online
- Make a payment on your account online
To access these services, follow these simple steps:
- Visit our website at: www.finemd.com
- Choose the “click here” button under “New! Patient Portal”
- Established patients: fill out the registration form so we can confirm you as an established patient.
- New patients: log in to request an appointment
We will process your information within the next business day and send you a notification email activating your account.
This is another way we strive to provide you with the highest level of service. As always, you can contact us by phone if you have any questions. We look forward to connecting with you online.
Finalists for the Emerald Award for Innovation
By Tony Reynolds, COT
The Emerald Award for Innovation honors existing businesses that have enhanced or reinvented their products, services, or practices through the successful implementation of innovative ideas.
Drs. Fine, Hoffman and Packer extend this philosophy further through innovative clinical research and international educational endeavors. They are continually involved in research and clinical investigations of the latest intraocular lens designs and cataract removal technologies. It is because of this relationship with the ophthalmic industry that Drs. Fine, Hoffman and Packer are able to offer the most advanced and safest cataract removal technology and the most advantageous intraocular lens designs to our patients many years before these technologies become available to the general public. This includes new multifocal and accommodative lenses that provide both near and distance correction in addition to the newest intraocular refractive lenses and refractive surgery lasers for our elective surgery patients.
“In today’s flat earth, with worldwide interconnectedness and competition, it has become crucial to success that every business identify and focus on providing uniquely innovative and creative solutions,” says Dr. Mark Packer. He continues, “In our business we are committed to meeting the challenges of eye disease and vision correction by offering the benefits of cutting-edge research and global insight to our community.”
It is this approach that has earned Drs. Fine, Hoffman and Packer the reputation for original thinking and improving the lives of others through technology and forward looking research. It is an honor being selected as one of the three finalists of the Emerald Award for Innovation by the Eugene Area Chamber of Commerce.
Dr. Fine was honored to give the Benedetto Strampelli Medal Lecture at the 13th Annual International Joint Meeting of Ocular Surgery News
Italian Society of Ophthalmology and the Italian Association of Cataract and Refractive Surgery. Dr. Fine lectured on phacoemulsification for difficult and challenging cases.
Dr. Hoffman was awarded the “2008 Best of Show” Award at the American Academy of Ophthalmology (AAO) Annual meeting in Atlanta, Georgia for his video presentation entitled “Scleral Fixation Without Conjunctival Dissection”. More than 150 videos were submitted to be considered for the AAO video presentation at the Ninth Annual “Best of Show” ceremony. It’s an accomplishment to have a video accepted for presentation, and quite an honor for it to be awarded “2008 Best of Show.” Bravo!
Congratulations to Edward Fine, Michelle Ryan, Ricki Shipway and Suwanna Smith for being the latest of our staff to achieve the Ophthalmic Coding Specialist (OCS) credential. The OCS exam is designed to provide learning and to thoroughly test the coding knowledge of professionals in ophthalmology, including: physicians, coders/billers, ophthalmic medical personnel, office managers, administrators, consultants, optometrists, and para-professionals.
One of our newest staff members, Katie Frank, has recently become certified as an Ophthalmic Assistant (COA). This is the first in a series of three certifications, and Katie is looking forward to the endless possibilities of personal and professional growth.[ top ]
Laura Reynolds has extensive medical front office experience. She has rejoined the medical field after raising her children. Laura has lived in Eugene/Springfield most of her life. She has been married for the past 19 years and has three wonderful children. Laura loves spending time with her family, watching her two younger children play basketball, football and soccer, and her oldest play the violin.
Rebekah Carter is our newest technician, joining us in August of last year. She graduated from the Ophthalmic Medical Technology Associates’ Program at Portland Community College in 2004, then from the U of O last spring. She is also an athlete, newlywed and now a valuable member of our team. She says, “I have wanted to work at this office ever since I moved to Eugene to go to school here in 2004. When I finally got the call to come in for an interview 4 years later I was very excited! I have really enjoyed working here for the last six months. I have learned a lot and look forward to learning a lot more. Working at this office has really opened my eyes to see the whole world of ophthalmology. I am very thankful and glad to be a part of this team.” Welcome, Rebekah! [ top ]
Blurry no more!
I would like thank Dr. Hoffman and his entire staff for their care and patience during my elective LASIK surgery. I had a great deal of anxiety during the pre-operative visits, even though I was very confident that I wanted to go through with the surgery. Dr. Hoffman suggested a mild sedative for the operation day. The sedative worked like a charm and I had no anxiety during the operation, but I still felt very aware and in control, just ….relaxed. The operation’s success was better than I had hoped for. My recovery was very quick. Within twenty four hours I had 20/20 vision with no blurriness or any side effects. It has been four months since my operation and I could not be happier with the results.
P.S. Last weekend I went to the coast on a misty day. It was the first time in twenty plus years that my glasses did not have ocean beach spray blurring my vision. Thank you Dr. Hoffman.
Sincerely, Bill Johnson
I feel like a kid again!
By Patrick Quigley
I have had the special “mono-vision”, also known as “blended-vision” performed by Dr. Packer last November. It has worked out splendidly for me. Mainly due to the prowess and great care of Dr. Packer and his associates!!
I am a very active 60 year old (windsurfing/skiing) so I was looking for correction for my near sightedness to enhance my sport activities, but just as important was the need to see up close for my job, which is graphic arts.
What I can tell you at this point is that I could not be happier with not only the procedure and care received, but the lasting results that have totally changed my life!! I have no night vision issues and can see better than I did with contacts. And the ability to read very small type and proof color without eyeglasses is huge. I can’t say enough about the staff, the total experience from day one and my new found freedom. I feel like a kid again and totally recommend it to anybody who wants to see both near and far.
One of my best decisions.
By Daniel Mackay
I approached the idea of having implantable Collamer lens (ICL) surgery with considerable anxiety. I have one set of eyes and if something were to go wrong, there are no eye transplants: I could lose my eyesight. The stakes were high. Compounding this fear, ever since I was a child, I hated having eye tests. I was overly sensitive to the bright lights and I could never keep my eye open for the burst of air during the glaucoma exam. How could I ever remain conscious when the doctor was operating on my eyes?
I did some investigation and it seemed pretty clear that Dr. Packer was one of the best ophthalmologists on the west coast. If I was going to put my eyesight on the line, I felt like Dr. Packer was a good doctor to perform the surgery. Now that I look back two years after the surgery, the most startling realization is that after all that build up of fear and anxiety, the surgery on both eyes went flawlessly. The nurses were great and helped to set me at ease and Dr. Packer was very professional. I guess we have the capacity to adjust to change pretty readily because after 26 years of wearing glasses I now almost take my 20/20 vision for granted, nearly forgetting all those years of struggling with glasses, contacts, and waking up to a blurry ceiling and a room that looked like it was painted by Monet. I went in for surgery one day and woke up the next and already I noticed a considerable difference.
Having the ICL surgery was truly one of best decisions I ever made. It ranks as one of the most life-changing events I’ve experienced. It must be a humbling experience for Dr. Packer to know that he has this kind of dramatic affect on the lives of his patients. I would heartily recommend ICL surgery with Dr. Packer for anybody considering it.
Drs. Fine, Hoffman, & Packer Travel/Teaching Schedule —
June through December 2008
June 28–July 3: Hong Kong, China
Dr. Packer gave ten presentations as an invited guest speaker at the XXXI International Congress of Ophthalmology in Hong Kong. His topics included How to Correct Post Cataract Surgery Refractive Surprises and Enhanced Control in Difficult and Challenging Cases.
July 11-13: Madison, WI
Dr. Fine was the invited guest speaker at the Extraordinary Ophthalmology Conference at the University of Wisconsin School of Medicine and Public Health, Department of Ophthalmology and Visual Science. Dr. Fine spoke on the future of cataract surgery.
July 29: Eugene, OR
Dr. Fine was delighted to be a guest lecturer for a fifth year in a row at Dr. Susan Verscheure’s Human Anatomy II course at the University of Oregon. Dr. Fine discussed how human anatomy is altered to correct visual defects or problems.
August 13-16: Cartagena, Colombia
Dr. Fine participated in the XXXIII Congresso Nacionale Internacional de Oftalmologicia meeting. Dr. Fine addressed such topics as clear corneal incisions, multifocal intraocular lens implants, and the state of the art of refractive lens exchange procedures.
September 13-17: Berlin, Germany
Drs. Fine and Packer participated in the XXVI Congress of the European Society of Cataract and Refractive Surgery Annual Meeting combined with the International Congress Centrum Annual Meeting. Both doctors participated in multiple courses and scientific symposia. Dr. Fine presented on Searching for Excellence in Cataract Surgery, new microscopy technology, and the correction of presbyopia with intraocular lens implants. Dr. Packer spoke on Micro Incision Cataract Surgery, prevention of complications and aspheric intraocular lenses.
September 24-27: Sevilla, Spain
Dr. Fine was invited to participate in the 84th Congress of the Spanish Society of Ophthalmology annual meeting. Dr. Fine presented on accommodating intraocular lens implants, the future of high performance phacoemulsification, and refractive lens exchange.
October 7: Chicago, IL
Dr. Packer presented an evening seminar program, Master Clinicians Presents The Cutting Edge: The Impact of Dry Eye Disease in Ophthalmic Surgery for the Postgraduate Institute for Medicine.
November 7-11: Atlanta, GA
The entire practice was an impressive force at the Annual Meeting of the American Academy of Ophthalmology (AAO) and Joint Meeting of the European Society of Ophthalmology. Drs. Fine, Hoffman and Packer gave multiple lectures and taught several courses on such topics as clinical decisions in management of cataract surgery complications; phacoemulsification, biaxial microincision phacoemulsification, IOL optics, and presbyopia-correcting IOLs. Dr. Hoffman’s submission to the video competition won Best of Show. In addition, Laurie Brown and Sue Stuhr each gave presentations in the Joint Commission on Allied Health Personnel in Ophthalmology’s Annual Meeting session on practice management. They focused on implementing electronic medical records and effective communication within the ophthalmic practice.
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